Big problems in search of small gains

April 30, 2015

Med J Aust 2015; 202 (7): 350.

doi:10.5694/mja15.00320

Authors: Steve McDonald, Tari Turner

From The Cochrane Library

We have known for some time that hormone therapy provides no protection against heart disease overall, but the latest Cochrane review update suggests there may be some benefit in the subgroup of recently postmenopausal women (aged between 50 and 59 years). However, only a small number of these women are likely to benefit, and potential harms include an increased risk of deep vein thrombosis. Despite data from more than 40 000 women drawn from 19 studies, hormone therapy remains a complex issue where the same treatment offers benefits in some women but harms in others (doi: 10.1002/14651858.CD002229.pub4).

Helping people with long-term conditions manage their own health is another complex area where small gains are often the best we can hope for. In personalised care planning, the patient and clinician jointly agree on goals and actions for managing the patient’s health problems. A new review of 19 studies, involving more than 10 000 participants, shows personalised care planning has some merit, probably leading to small improvements in some indicators of physical health, such as better blood glucose levels and lower blood pressure (doi: 10.1002/14651858.CD010523.pub2). Unsurprisingly, the process worked best when the support was intensive and when it was integrated into routine care.

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